Testimony to Oregon Health Policy Board

by Michael Huntington MD, Retired radiation oncologist, Corvallis, Oregon. 

Nov. 30, 2024

Thank you for all the work you and the Oregon Health Policy Board staff have done to oversee the Oregon Health Authority and make Coordinated Care Organizations successful. Most patients I talk with are happy with the care they receive from CCOs. 

However, at some point, many Oregonians must choose between accepting a raise or becoming an entrepreneur versus retaining their health care for their families through Medicaid eligibility. No matter how high we place the threshold for eligibility, a fiscal cliff remains.

Since about 1970, health care policy leaders have persuaded us that the high cost of health care is due to over utilization. We, therefore, embrace managed care systems that incentivize health care providers to restrict care. However, the US underutilizes health care services compared to other countries, and our outcomes suffer. We consider fee-for-service payment to be a prime contributor to our high costs. To solve the perceived problem of fee-for-service, we use capitation and value-based payment systems. But these systems can create as many problems as they solve.  They require care providers and their helpers to divert time from patient care and provider recuperation into the tedious and proforma entering of billing-related verbiage that obfuscates essential clinical information. This ritual results in high administrative, financial, physical, and emotional costs to providers and degraded care for patients. And such capitated systems entail perverse incentives to avoid costly patients and lead to burnout, moral injury, and early retirement of health care providers.

Please read the attached article by Stephen Kemble, M.D., retired psychiatrist and Hawaii Health Authority Board member. Dr. Kemble has also served as president of the Hawaii Psychiatric Medical Association and the Hawaii Medical Association.

The article proposes a system of fee-for-time payment for health care providers that will alleviate the many problems associated with standard fee-for-service and value-based payment systems.  Although the article focuses on the rationale for a national single-payer system, most concepts apply to state-based universal healthcare.

Dr. Kemble raises two possibilities for Oregon. One is that a fee-for-time payment system could be incorporated into our current health care systems. In addition, Oregon could proceed as quickly as possible to a state-based universal health care plan that could incorporate fee-for-time payments.  The Legislature and the Governor have directed the Oregon Universal Health Plan Governance Board to create such a plan. 

Today, as members of the Oregon Health Policy Board, I ask you to help the Governance Board reach its goal as intended by the Legislature. I praise you for the work you have done to help Oregon manage healthcare under our current healthcare-is-a-business model. However, healthcare as a business is failing us dramatically. Please show a strong interest in what the Governance Board is doing and help the Board reach its goal. Your children and grandchildren may thank you for allowing them health care that is not dependent on their job, income, class, gender, gender identity, age, spouse, ZIP Code, or a boardroom in Minnesota or Massachusetts.

Also, please turn the management of CCOs back to direct state control without private intermediaries. Fourteen years ago, Connecticut took back direct control of its Medicaid program. Costs decreased by 14%, and health outcomes improved.